Department of Anesthesia and Intensive Care, Hôpital Privé de l'Estuaire, 505 rue Irene Joliot Curie, Le Havre, 76620, France.
Département d'Anesthésie-Réanimation, Centre Hospitalier Intercommunal de Fréjus Saint-Raphaël, 240 Avenue de Saint Lambert, Fréjus, 83600, France.
BMC Anesthesiol. 2024 Jul 29;24(1):260. doi: 10.1186/s12871-024-02651-1.
Because of the adverse effects of morphine and its derivatives, non-opioid analgesia procedures are proposed after outpatient surgery. Without opioids, the ability to provide quality analgesia after the patient returns home may be questioned. We examined whether an opioid-free strategy could ensure satisfactory analgesia after ambulatory laparoscopic colectomy.
We performed a retrospective observational single-center study (of prospective collected database) including all patients eligible for scheduled outpatient colectomy. Postoperative analgesia was provided by paracetamol and nefopam. Postoperative follow-up included pain at mobilization (assessed by a numerical rating scale, NRS), hemodynamic variables, temperature, resumption of transit and biological markers of postoperative inflammation. The primary outcome was the proportion of patients with moderate to severe pain (NRS > 4) the day after surgery.
Data from 144 patients were analyzed. The majority were men aged 59 ± 12 years with a mean BMI of 27 [25-30] kg/m. ASA scores were 1 for 14%, 2 for 59% and 3 for 27% of patients. Forty-seven patients (33%) underwent surgery for cancer, 94 for sigmoiditis (65%) and 3 (2%) for another colonic pathology. Postoperative pain was affected by time since surgery (Q3 = 52.4,p < 0.001) and decreased significantly from day to day. The incidence of moderate to severe pain at mobilization (NRS > 4) on the first day after surgery was (0.19; 95% CI, 0.13-0.27).
Non-opioid analgesia after ambulatory laparoscopic colectomy seems efficient to ensure adequate analgesia. This therapeutic strategy makes it possible to avoid the adverse effects of opioids.
The study was retrospectively registered and approved by the relevant institutional review board (CERAR) reference IRB 00010254-2018 - 188). All patients gave written informed consent for analysis of their data. The anonymous database was declared to the French Data Protection Authority (CNIL) (reference 221 2976 v0 of April 12, 2019).
由于吗啡及其衍生物的不良反应，在门诊手术后提出了非阿片类镇痛程序。没有阿片类药物，患者回家后提供高质量镇痛的能力可能受到质疑。我们研究了非阿片类药物策略是否可以确保腹腔镜结肠切除术后门诊患者的镇痛效果令人满意。
我们进行了一项回顾性观察性单中心研究（前瞻性收集数据库），包括所有符合计划门诊结肠切除术的患者。术后镇痛采用对乙酰氨基酚和奈福泮。术后随访包括活动时疼痛（用数字评分量表评估，NRS）、血流动力学变量、体温、转移恢复和术后炎症的生物学标志物。主要结局是术后第一天有中度至重度疼痛（NRS＞4）的患者比例。
分析了 144 例患者的数据。大多数患者为男性，年龄 59±12 岁，平均 BMI 为 27[25-30]kg/m。ASA 评分分别为 1 分（14%）、2 分（59%）和 3 分（27%）。47 例（33%）患者因癌症接受手术，94 例因乙状结肠炎（65%）接受手术，3 例（2%）因其他结肠疾病接受手术。术后疼痛受手术时间影响（Q3=52.4，p＜0.001），且逐日显著下降。术后第一天活动时发生中度至重度疼痛（NRS＞4）的发生率为（0.19；95%CI，0.13-0.27）。
门诊腹腔镜结肠切除术后非阿片类镇痛似乎能有效确保足够的镇痛效果。这种治疗策略可以避免阿片类药物的不良反应。
该研究经相关机构审查委员会（CERAR）批准（IRB 00010254-2018-188），并进行了回顾性注册。所有患者均签署了分析其数据的书面知情同意书。匿名数据库已向法国数据保护局（CNIL）申报（2019 年 4 月 12 日第 2212976v0 号）。
